Changes in glycaemic control of oral anti-diabetic medications assessed by continuous glucose monitors among patients with type 2 diabetes: a protocol of network meta-analysis.

BACKGROUND: Continuous glucose monitors (CGMs) can measure interstitial fluid glucose levels to provide comprehensive real-time glucose profile among people with type 2 diabetes. These can accurately detect glucose levels, hyperglycaemia and hypoglycaemia events compared with conventional self-monitoring. Increased application of CGMs provides a valuable opportunity to evaluate glucose control on oral anti-diabetic medications. This review will compare the efficacy and safety of oral anti-diabetic medications among patients with type 2 diabetes, evaluated by CGM. METHODS: The following databases will be searched: Cochrane Library, PubMed, EMBASE, CINAHL, PsycINFO, Scopus and grey literature (ClinicalTrials.gov, PsycEXTRA, ProQuest Dissertations, Google Scholar and Theses Global) for the identification of studies. The review will include and summarise evidence from randomised clinical trials that use CGMs for blood glucose management in adults (aged ≥ 18 years), published in English between January 2000 and May 2021 without any restrictions of countries. Reference list of all selected articles will independently be screened to identify additional studies left out in the initial search. Primary outcomes will be HbA1c (≤ 7.0%), time spent with hypoglycaemia (< 70 mg/dl) or hyperglycaemia (≥ 180 mg/dl). Secondary outcomes will be change in weight, blood pressure and related comorbidities (cardiovascular mortality, heart failure events, myocardial infarction and stroke). Study selection, data extraction and quality assessment will be conducted independently by at least two reviewers. A third reviewer will determine and resolve discrepancies. At least two independent reviewers will cross-check data synthesis. The quality of evidence of the review will be assessed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Tool. DISCUSSION: The review is anticipated to provide up to date evidence for further studies and clinic practices regarding glycaemic control, hypoglycaemia, and hyperglycaemia issues. The results will be published in a peer-reviewed journal. TRIAL REGISTRATION: PROSPERO CRD42020188399 .

Barriers and facilitators of diabetes management by continuous glucose monitoring systems among adults with type 2 diabetes: a protocol of qualitative systematic review.

INTRODUCTION: Studies suggest that continuous glucose monitors (CGMs) play an important role in the management of diabetes. Although general acceptance has been reported by patients with type 2 diabetes towards the use of CGMs, potential barriers exist like pain due to sensor insertion, accidental removal of the device or adhesive strip, impacts of daily activities, skin reactions to sensor adhesive, etc. This systematic review of qualitative studies aims to explore the perspectives, experiences and narratives of patients and caregivers about CGM use, and its barriers and facilitators. METHODS AND ANALYSIS: This review will include qualitative studies and cross-sectional and longitudinal cohort studies using open-ended questions, published in English by 30 October 2021. The following electronic databases will be searched: Cochrane Library, PubMed, EMBASE, CINAHL, PsycINFO and Scopus. A search of grey literature will be conducted via an online search of Google Scholar, WorldCat, ClinicalTrials.gov and OpenGrey A combined search strategy using medical subject headings (MeSH), controlled vocabulary and 'free-text' terms will be appropriately revised to suit each database. Primary outcomes will include patient and caregiver perspectives on diabetes management regarding glucose control; living with CGM (quality of life, experience of wearing a CGM); psychological aspects (anxiety, depression, emotional burden); barriers (technical issues, financial issues) to use of CGM and thoughts (interpretation, understanding) on the CGM report. A qualitative meta-synthesis will be conducted employing a systematic literature search of existing literature, quality assessment using study-specific tools and an aggregative thematic synthesis by a multidisciplinary team. ETHICS AND DISSEMINATION: Ethical approval is not required since this is a systematic review. The results will help improve clinical implementation of CGMs on part of both patients and caregivers. PROSPERO REGISTRATION NUMBER: CRD42020152211.

Dose Correlation of Danggui and Chuanxiong Drug Pairs in the Chinese Medicine Prescription Based on the Copula Function.

Dosage is essential for studying the compatibility and effectiveness of traditional Chinese medicine. Danggui and Chuanxiong are widely used in traditional Chinese medicine for ailments and treatment of various disorders. 628 traditional Chinese medicine prescriptions containing Danggui and Chuanxiong were extracted from the self-built prescription database and screened for the three groups of prescriptions, i.e., irregular menstruation, sores, and stroke. We processed and tested the dosage of Danggui and Chuanxiong and selected the optimal copula function, Gumbel copula function, from the Archimedes function family and elliptical copula function family to establish the data model. To establish the presence of a correlation between the dose of Danggui and Chuanxiong, a graph of the joint distribution function of rank correlation coefficients, Kendall's rank correlation coefficient and Spearman's rank correlation coefficient, was used. Our results suggest that the model using the Gumbel copula function better reflects the correlation between the dose of Danggui and Chuanxiong. For irregular menstruation, sores, and strokes, Kendall's rank correlation coefficients were 0.6724, 0.5930, and 0.7757, respectively, and Spearman's correlation coefficients were 0.8536, 0.7812, and 0.9285, respectively. In all three prescription groups, the dose of Danggui and Chuanxiong was positively correlated, implying that, as the dosage of one drug increases, the dosage of the other increases as well. From the perspective of data mining and mathematical statistics, the use of the copula function model to evaluate the correlation between the prescribed dosage of the two drugs was innovative and provided a new model for the scientific interpretation of the compatibility of traditional drugs. This might also serve to guide the clinical use of traditional Chinese medicine.

Inhibition of berberine hydrochloride on Candida albicans biofilm formation.

OBJECTIVE: This study aimed to investigate the inhibitory effect of berberine hydrochloride (BH) on Candida albicans (C.albicans) ATCC10231 biofilm formation. RESULTS: This paper found a positive correlation between the concentration of BH and its inhibitory effect on the cellular activity of early biofilms because we found that 128 and 32 µg/mL BH significantly inhibited biofilm formation (P < 0.05). BH significantly inhibited the cellular activity in early biofilms, destroyed the microscopic morphology of C.albicans and reduced the thickness of the biofilm. Both 128 and 32 µg/mL concentration solutions of BH significantly inhibited biofilm formation (P < 0.05). We found that the inhibitory effect of BH solution was positively correlated with its concentration and 128 µg/mL BH was better than 4 µg/mL fluconazole. Additionally, the results of RT-PCR indicated that 128 and 32 µg/mL BH inhibited the expression of EFG1, HWP1, ECE1, and ALS1 (P < 0.05). CONCLUSION: The efficacy of BH in inhibiting the formation of C.albicans biofilm by killing the cells in the biofilm and destroying its structure; and the mechanism may be to down-regulate the expression of EFG1, HWP1, ECE1, and ALS1 in hyphae formation, thereby, retarding the morphological transformation of C. albicans.

Exploring how lifestyle weight management programmes for children are commissioned and evaluated in England: a mixed methodology study.

OBJECTIVE: To assess how lifestyle weight management programmes for children aged 4-16 years in England are commissioned and evaluated at the local level. DESIGN: This was a mixed-methods study comprising an online survey and semistructured telephone interviews. SETTING: An online survey was sent to all local authorities (LAs) in England regarding lifestyle weight management services commissioned for children aged 4-16 years. Online survey data were collected between February and May 2016 and based on services commissioned between April 2014 and March 2015. Semistructured telephone interviews with LA staff across England were conducted between April and June 2016. PARTICIPANTS: Commissioners or service providers working within the public health department of LAs. MAIN OUTCOME MEASURES: The online survey collected information on the evidence base, costs, reach, service usage and evaluation of child lifestyle weight management services. The telephone interviews explored the nature of child weight management contracts commissioned by LAs, the type of outcome data collected and whether these data were shared with other LAs or organisations, the challenges faced by these services, and the perceived 'markers of success' for a programme. RESULTS: The online survey showed that none of the participating LAs was aware of any peer-reviewed evidence supporting the effectiveness of their specific commissioned service. Despite this, the telephone interviews revealed that there was no national formal sharing of data to enable oversight of the effectiveness of commissioned services across LAs in England to help inform future commissioning decisions. Challenges with long-term data collection, service engagement, funding and the pressure to reduce the prevalence of obesity were frequently mentioned. CONCLUSIONS: Robust, independent, cost-effectiveness analyses of obesity strategies are needed to determine the appropriate allocation of funding to lifestyle weight management treatment services, population-level preventative approaches or development of whole system approaches by an LA.